Abdominal Pain: A Common Presentation of Dengue Fever

Abstract

Dengue fever (DF) is a mosquito born viral disease caused by dengue virus and is endemic in large areas of southeast of Asia. Pakistan is an endemic country for dengue virus infection. Abdominal pain is a commonly reported symptom in dengue fever (DF). The most common causes of abdominal pain are acalculus cholecystitis, ascites, acute pancreatitis, acute hepatitis, pleural effusion and peptic ulcer disease.

Study design: A Case Series Study.

Place and Duration of Study: This study was conducted at Mayo and Lady Willingdon Hospitals, Lahore from September and October 2011.

Materials and Methods:  105 patients with fever and abdominal pain admitted to Mayo and Lady Willingdon Hospitals, Lahore during months of September and October 2011 were included in the study. A provisional diagnosis of dengue fever was made based on the presence of acute febrile illness and two of the following features :headache, retro orbital pain, myalgia, arthralgia , skin rash, hemorrhagic manifestations and leucopenia. The diagnosis was confirmed by enzyme immunoassay based serology. The cause of pain was determined by blood tests (Serum  Amylase , serum lipase, liver function tests {LFTs} ) and radiology ( ultrasound, contrast enhanced  CT {CECT} and chest xray {CXR} ) except for pregnant patients. 67 patient had dengue fever and 38 patient had other causes of fever and abdominal pain. In patient with dengue fever causes of abdominal pain were acalculus cholecystitis, ascites, acute pancreatitis, acute hepatitis, pleural effusion and peptic ulcer disease. Among 67 patients 2 were pregnant, one at 28 weeks and other at 32 weeks of gestation.

Results: Results of this study show that among 105 patients having fever and abdominal pain, 67 patients had serologically proven dengue fever. Table I shows that among patients with serologically proven dengue fever 29 had acalculus cholecystitis, 14 had ascites, 9 had acute pancreatitis, 11 had gastrointestinal disorder and 4 had bilateral pleural effusion. Among 3 patients with menorrhagia 2 had acalculus cholecystitis and 1 had gastrointestinal disorder. 2 patients were pregnant at 28 and 32 weeks of gestation. Both of them had peptic ulcer disease. Among 67 patients, 47 were male and 20 were female. Ages of patients range from 15 to 62 years. All patients had temperature ranging from 101°F to 104°F while mean duration of fever was 5 days.

In patient with dengue fever etiology of abdominal pain should be aggressively looked into for proper and better management.

Conclusion: If carefully looked into, the etiology of abdominal pain in dengue fever can be found and appropriately managed.